Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule
CMS released its final rule on November 1, 2023, surrounding the 2024 Medicare Physician Fee Schedule, that will take effect January 1, 2024. Below are some key highlights.
CY 2024 PFS Rate Setting and Conversion Factor
CMS to decrease the conversion factor from $33.89 to $32.75 (3.34% decrease) – part of the expiring conversion factor relief enacted by Congress. Anesthesia drops to $20.44 (3.26% decrease). This continues the trend of reductions to the conversion factor adding to the challenges facing physician practices in the midst of inflation, labor shortages, and aging population. CMS is also finalizing significant increases in payment for primary care and other kinds of direct patient care.
E/M Code Add-On
CMS proposes to make add-on code G2211 for office/outpatient evaluation and management (E/M) complexity. This is currently a bundled code. This add-on code will better recognize the resource costs associated with evaluation and management visits for primary care and longitudinal care. This could be a big win for Primary Care physicians. CMS To Reimburse G2211 in 2024 – HMS Valuation Partners (hmsvalue.com)
CMS to pay Telehealth services reported with Place of Service (POS) 02 (telehealth provided other than in patient’s home) at the facility rate and 10 (telehealth provided in patient’s home) at the non-facility PFS rate to protect access to mental health and other telehealth services by aligning with telehealth-related flexibilities that were extended via the CAA, 2023. In addition, CMS is suspending frequency limitations for subsequent inpatient visits, subsequent nursing home visits, and critical care services.
Medicare Part B Payment for Preventive Vaccine Administration Services
In June 2021, CMS announced an additional payment for in-home COVID-19 vaccine administration, which was established on a preliminary basis during the PHE. Effective January 1, 2024, the payment amount for the in-home administration of all four vaccines will be identical, that is, Medicare Part B will pay the same additional payment amount to providers and suppliers that administer a pneumococcal, influenza, hepatitis B, or COVID-19 vaccine in the home.
Behavioral Health Services
CMS to Increase the work RVUs for general behavioral health integration care management (code 99484) and establish new G-codes for behavioral health crisis services furnished in any non-facility POS other than the physician’s office. Specifically, CMS proposes to increase the work RVUs for General Behavioral Health Integration Care Management (CPT code 99484) from 0.61 to 0.93.
For further details see AAFP article: ES-2024MPFSProposedRule-072623.pdf